Toronto physician and researcher Dr. Shail Rawal is the lead author of a study published in the Journal of the American Medical Association suggesting hospitals across Canada provide professional interpreters for patients with limited English skills.THE CANADIAN PRESS/HO-The General Medicine Inpatient Initiative (GEMINI) MANDATORY CREDIT

Toronto physician and researcher Dr. Shail Rawal is the lead author of a study published in the Journal of the American Medical Association suggesting hospitals across Canada provide professional interpreters for patients with limited English skills.THE CANADIAN PRESS/HO-The General Medicine Inpatient Initiative (GEMINI) MANDATORY CREDIT

Patients lacking English need equal access to interpreters across Canada: doctor

Patients with a chronic disease and limited English are more likely to return to the emergency room

Waking up with worsening pain had Surjit Garcha worried, but the red blisters on her stomach were so alarming that she went to her neighbour’s home to try and explain, in her limited English, that she needed help.

Garcha, who lives alone, doesn’t have the English skills to call her doctor’s office and felt more comfortable going to someone she trusts.

Her neighbour took her to the emergency department in Delta, B.C., where Garcha learned she had shingles, a viral infection that can include complications such as scarring and vision and hearing loss in older adults.

Garcha, now 82, said the intense pain was bad enough but not being able to understand what was wrong with her made her feel even more vulnerable.

“The employees who bring food to patients would leave it outside the door because they could catch what I had and no visitors could come in my room,” she said in Punjabi about her experience three years ago.

Garcha’s only solace was that a nurse spoke Punjabi, but it wasn’t until her daughter arrived from Seattle the next day that she had any contact with a family member.

Interpreters trained in medical terminology are more often provided for patients in Canada’s larger centres, but a researcher from the University of Toronto said lack of access to interpretation could potentially result in unsafe health care through missed diagnoses and medical errors, suggesting language services should be a priority.

Dr. Shail Rawal, lead author of a study that includes data from Toronto General and Toronto Western hospitals, said patients with a chronic disease and limited English are more likely to return to the emergency room or be readmitted to hospital because of poorer understanding of discharge instructions and not taking medication as required compared with those who are proficient in the language and were discharged with similar health concerns.

The study was published recently in the Journal of the American Medical Association and includes data for all patients discharged from the two hospitals with acute conditions, pneumonia and hip fracture, and chronic conditions heart failure and chronic obstructive pulmonary disease, between January 2008 and March 2016, amounting to 9,881 patients.

“We saw that if you had heart failure and limited English proficiency you were more likely to come back to the emergency room to be reassessed in 30 days after you were discharged,” said Rawal, an assistant professor in the University of Toronto’s department of medicine and a staff physician at the University Health Network, which includes the two hospitals.

“Patients who had limited English proficiency and heart failure or chronic obstructive lung disease were more likely to be readmitted to hospital in the 30 or 90 days after discharge,” she said.

For those with pneumonia or hip fracture, the data showed no difference in return to hospital regardless of patients’ ability to speak English, Rawal said.

“Our thinking is that those are acute conditions that have a pretty standard treatment, whether it be surgery and then rehabilitation or a course of antibiotics whereas the two chronic conditions require a lot of patient-centred counselling and patient management plans.”

Of the 9,881 patients, 2,336 people had limited proficiency in English. Nearly 36 per cent of them spoke Portuguese, just over 23 per cent spoke Italian while Cantonese, Mandarin and Chinese were the primary languages for about 14 per cent of patients. Greek and Spanish were the least-spoken languages and 18.5 per cent of the study subjects’ languages were listed as “other.”

ALSO READ: Canadian doctors say political activism part of their jobs on issues affecting health

Rawal said patients at the two hospitals have around-the-clock access to interpretation in various languages by phone and in-person interpretation is also available but must be pre-booked and is typically offered during business hours.

“The quality of care or the level of access to interpretation, in my view, should not vary based on which hospital you happen to present at with your illness,” she said. “Currently, that is the case, that depending on what hospital you go to in our city, in our province or across the country, you will have varying levels of access to professional interpretation services and I think that in a linguistically diverse country the language needs of patients and families should be met by institutions.”

Family members often step in to interpret and alleviate a patient’s anxiety but may end up having to rearrange their schedules while waiting for nurses, doctors or specialists to show up at the bedside, Rawal said.

However, she said previous research studies have shown that families are less accurate in their interpretation than professionals and sometimes may not wish to translate what a clinician is saying, perhaps to lessen the impact if the prognosis would be too upsetting.

Kiran Malli, director of provincial language services for the Provincial Health Services Authority in British Columbia, said patients in Vancouver and the surrounding area have access to 180 languages through interpreters who work at hospitals and publicly funded long-term care homes.

The top three languages are Cantonese, Mandarin and Punjabi, Malli said.

In-person and phone interpretation is provided without a pre-booked appointment and the health authority started a pilot project last year to provide services by phone to family doctors’ offices, she said.

Another pilot on video-remote interpreting at hospitals, which Malli said would greatly benefit patients needing sign language, which is already being provided, will also start soon and benefit those living in isolated parts of the province.

A few scattered grassroots programs were available in British Columbia in the 1990s but the current standardized one didn’t start until 2003, she said.

“It was getting pretty evident that we needed to do something a little more than just pulling up any bilingual person or calling on the overhead paging (system) to say ‘If anybody speaks Cantonese could you please come to emergency,’” Malli said of the current program’s genesis.

“Research shows us that as people get older, even if you know English when you’re younger you tend to revert back to your mother tongue as you age,” she said, adding elderly people in medical distress tend to forget the English skills they have.

“I do think we are seeing more elderly patients for that reason,” she said.

It’s unfair for health-care staff to expect family members to act as interpreters because just like for English-speaking patients’ relatives, their role should be to support their loved ones and not to be burdened further, Malli said.

“If we are looking at equity, as family I should just be there to support my family member through whatever it might be rather than act as their language conduit.”

Camille Bains, The Canadian Press

Get local stories you won't find anywhere else right to your inbox.
Sign up here

Just Posted

Read the full 2019-2020 annual report report online at www.seabirdisland.ca.
Seabird Island looks back in 2019-20 report

Highlights include COVID response, new development, upgrades

Signs up at Hope Secondary School inform visitors that the school is a closed campus during the coronavirus pandemic. (Emelie Peacock/Hope Standard)
Fourth COVID-19 exposure reported at Hope Secondary School

Nov. 27 exposure two days after another exposure at the school, with five exposures total across SD78

Chief Robert Gladstone of Shxwha:y Village at a federal flood funding announcement April 24, 2019. (Jenna Hauck/Chilliwack Progress file)
Consortium of Indigenous chiefs seeking a way to participate in cannabis economy

All Nations Chiefs from the Shxwha:y, Cheam, Soowahlie and Sq’ewlets holding online forum Dec. 2

Harrison mayor Leo Facio, Kent mayor Sylvia Pranger and organizer Rose Tustian (far right) at the Salvation Army kettle in Agassiz in this 2017 photo. (Contributed Photo/Rose Tustian)
Local Salvation Army kettle campaign kicks off Saturday

Municipal, provincial dignitaries to volunteer

Students at the Chilliwack campus of the University of the Fraser Valley. (Darren MacDonald/ UFV)
UFV asking students to voluntarily report COVID cases and exposures to the school

With COVID cases rising and Fraser Health struggling to keep up, students are asked to help

Mary Cox and Jack Plant dance in their pyjamas and slippers at the morning pyjama dance during the Rhythm Reelers’ 25 Annual Rally in the Valley Square Dance Festival in Chilliwack on June 4, 2011. Sunday, Nov. 29, 2020 is Square Dancing Day. (Jenna Hauck/ Chilliwack Progress file)
Unofficial holidays: Here’s what people are celebrating for the week of Nov. 29 to Dec. 5

Square Dancing Day, Disability Day and International Ninja Day are all coming up this week

Black Press Media and BraveFace have come together to support children facing life-threatening conditions. Net proceeds from these washable, reusable, three-layer masks go to Make-A-Wish Foundation BC & Yukon.
Put on a BraveFace: Help make children’s wishes come true

Black Press Media, BraveFace host mask fundraiser for Make-A-Wish Foundation

Screenshot of Pastor James Butler giving a sermon at Free Grace Baptist Church in Chilliwack on Nov. 22, 2020. The church has decided to continue in-person services despite a public health order banning worship services that was issued on Nov. 19, 2020. (YouTube)
2 Lower Mainland churches continue in-person services despite public health orders

Pastors say faith groups are unfairly targeted and that charter rights protect their decisions

A big job: Former forests minister Doug Donaldson stands before a 500-year-old Douglas fir in Saanich to announce preservation of some of B.C.’s oldest trees, July 2019. (B.C. government)
B.C. returning to ‘stand-alone’ forests, rural development ministry

Horgan says Gordon Campbell’s super-ministry doesn’t work

Join Black Press Media and Do Some Good
Join Black Press Media and Do Some Good

Pay it Forward program supports local businesses in their community giving

Cannabis bought in British Columbia (Ashley Wadhwani/Black Press Media)
Is it time to start thinking about greener ways to package cannabis?

Packaging suppliers are still figuring eco-friendly and affordable packaging options that fit the mandates of Cannabis Regulations

Peter Wilson, left, and Micah Rankin, right, formed the Special Prosecutor team that was tasked with reviewing and litigating charges stemming from the Bountiful investigation. Trevor Crawley photo.
End of Bountiful prosecution wraps up decades of legal battles

Constitutional questions had to be settled before a polygamy prosecution could move forward

Despite rumours, Surrey RCMP say they are not issuing tickets to people if they are driving in a vehicle with others from a different household. (File photo)
COVID-19 tickets: No, RCMP aren’t checking vehicle occupancies, restaurant tables

Enforcement about education, not punishment says Surrey RCMP Cpl. Joanie Sidhu

Alexandre Bissonnette, who pleaded guilty to a mass shooting at a Quebec City mosque, arrives at the courthouse in Quebec City on February 21, 2017. THE CANADIAN PRESS/Mathieu Belanger - POOL
Court strikes down consecutive life sentences; mosque shooter has prison term cut

The decision was appealed by both the defence and the Crown

Most Read